Is It Time to Stop Taking the Pill?

I started taking the pill when I was in college, not as a method of birth control, but because it was the only thing that worked to quell the debilitating symptoms –- agonizing cramps, headaches, and severe nausea –- that accompanied my monthly period.

About 10 years ago, I briefly went off the pill, mostly because it seemed like a good idea to give my body a break, and because of some vague concerns about breast cancer. The returning menstrual pains were more than merely unpleasant. A month after stopping the pill, I suffered an episode of such horrible cramps and vomiting that I couldn’t get up off my office floor. My boss had to call someone to pick me up and take me home. That day pretty much sealed the deal for me: If it meant staying on birth control pills forever, it seemed better than the painful alternative.

But when I hit 40, those nagging second thoughts returned. What were the long-term risks of being on a hormone-derived prescription drug –- and did the benefits (being period- and symptom-free) outweigh the risks? I began to do some research.

The first thing I learned is that the birth control pill is one of the most commonly prescribed drugs for women of childbearing age. Nearly 10 million American women, ages 15 to 44, use the pill, according to the Guttmacher Institute, an organization that advances sexual and reproductive health worldwide through research, policy analysis and public education. The more serious side effects like blood clots are more common in women over the age of 35. Even for women like me who are healthy, don’t smoke, and maintain a healthy weight, the risk of blood clots increases with age.

Suddenly, Side Effects

For many years I’d been on Loestrin, a low-estrogen pill that had worked well for me. I experienced none of the reported side effects, such as weight gain, moodiness, and breast tenderness and swelling. But then, just as I was rethinking my reliance on the pill, Loestrin was discontinued and my prescription was automatically changed to Microgestin, a pill with similar amounts of estrogen and progestin. Suddenly I began to suffer severe bouts of dizziness. I quickly realized the dizziness coincided with the change in my prescription, since I was taking no other medications and had no apparent health issues.

I made an appointment to see my OB-GYN and told her about my severe and frequent dizzy spells that I thought were related to the Microgestin. She dismissed my concerns, saying I most likely had an inner ear infection and that I should see my primary care physician or even a neurologist for testing. I left her office concerned that my dizziness could be something more serious.

Feeling anxious, I immediately pulled out my phone and Googled Microgestin, reading through the common side effects listed by the manufacturer and scanning online user message boards. I quickly learned that dizziness can be a side effect of the drug and that it can worsen with the use of alcohol. (I’m a wine lover and drink at least a few glasses a week.) No doctor had ever told me about the potential link between alcohol, birth control pills and dizziness; and quite frankly, I was surprised –- and annoyed –- that Google seemed to be a more reliable educational tool than my New York City OB-GYN.

Making an Informed Decision

Armed with this new information, I decided to dig a little deeper. I put in a call to Draion Burch, DO, OB-GYN clinical assistant professor in the department of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine. (Dr. Burch –- or Dr. Drai, as he’s known to his patients –- is not only a recognized OB-GYN but also an osteopathic physician, a doctor with a more holistic approach to treating patients. I thought he might be a bit more inclined to reveal any potential long-term prescription side effects than a traditional MD.)

FAST FACT: 14% of pill users (1.5 million women) take the pill exclusively for non-contraceptive purposes, and 58% take it in part for reasons other than contraception. Among the latter group, the most common reason (31%) was to reduce cramps or menstrual pain.

Source: Guttmacher Institute

Dr. Drai began by outlining some of the common short-term side effects of the pill: bloating, nausea, breast tenderness, and breakthrough bleeding. I was lucky never to have suffered any of those side effects. We then moved on to discuss more serious, long-term side effects like the risk of blood clots for women over 35, which he confirmed is true and is even more significant for women who smoke or who are overweight.

In discussing my own situation, I mentioned that I have a family history of arrhythmia, a potentially fatal heart rhythm disorder that can lead to sudden cardiac arrest. My father, who had low cholesterol, normal blood pressure, and maintained a healthy weight, went into sudden cardiac arrest from a nearly fatal arrhythmia. His long road to recovery included a lengthy stint in rehab and the installment of an internal cardiac defibrillator –- an advanced type of pacemaker. A paternal aunt also suffered from arrhythmia, though her condition was less serious and well-managed by medication.

Since arrhythmias are linked to blood clots and have a strong genetic component, I asked Dr. Drai if this should factor into my decision about the pill. He said that at this point –- despite my family history -– I am at no greater risk of developing blood clots than anyone else over 40. But, he cautioned, if I’m ever diagnosed with any type of heart condition, including arrhythmia, I should stop taking birth control pills right away.

Looking for more reassurance, I tracked down a study on heart disease, blood clots, and hormonal contraceptives published in the New England Journal of Medicine in 2012. In that study, researchers at the University of Copenhagen observed more than 1.6 million Danish women ages 15 to 49, from 1995 to 2009, and found that low-dose estrogen pills pose a low risk of blood clot-related heart attacks or strokes. 

A more-recent report from researchers at Loyola University Chicago Stritch School of Medicine notes that the pill increases the risk of ischemic strokes — those that are caused by blood clots. The stroke risk is very small in healthy young women with no stroke risk factors, such as high blood pressure, smoking or migraine headaches. But women with any of these risk factors should not take the pill, the researchers concluded. That warning concurs with the one Dr. Drai gave me about the pill and heart disease: If I’m ever diagnosed with any type of heart condition I should stop taking birth control pills right away. 

A newer concern is that if women taking a birth control pill containing estrogen become infected with COVID-19, their risk of developing blood clots could be even higher. According to a 2020 report published in the journal Endocrinology, previously healthy people have developed blood clots as a complication of coronavirus infection. That risk could be compounded in women who are pregnant, using hormone replacement therapy or taking birth control pills. So COVID-19 infection could present another reason a woman may need to discontinue pill use. 

The risk for blood clot-related heart attack or stroke increases with age, particularly for women over 35. Before prescribing the pill, a healthcare provider will ask questions about a woman’s age, personal and family health history, cigarette use, and check weight, body mass index and blood pressure, among other factors.

My next step was to call my OB-GYN and ask her to prescribe a different pill. I told her about my dizziness, so she switched me to another low-estrogen pill called Lomedia. This time, before filling my prescription, I did some research on the drug and trolled message boards to learn how other pill users dealt with side effects such as dizziness. In short order, I incorporated some of their advice into my pill-taking routine:

• I now take the pill at night (at precisely the same time) so it metabolizes while I’m sleeping.
• I down it with a large glass of water.
• I watch my alcohol intake. These days, I rarely drink wine on weekdays and try to limit my weekend alcohol intake as well.

These three things made an immediate difference in easing my dizziness. But I should also add that Lomedia is considered equivalent to Loestrin, the pill I was on for many years. So it’s possible this formulation is simply a better fit for my body.

With my side effects in check, I still needed to decide whether I wanted to continue taking the pill. So I drew up a list of the pros and cons, based on my own research and some guidance from Dr. Drai. Here’s what I learned:

Pros

Oral contraceptives may:

• Alleviate the symptoms of premenstrual syndrome, or PMS (my biggest pro)
• Regulate the menstrual cycle (For years, I haven’t had a period at all, which is typical for some women on today’s low-estrogen formulas.)
• Prevent acne (which is why they’re often prescribed to teenage girls off-label)
• Prevent endometriosis
• Decrease the risk of endometrial, colorectal and ovarian cancer
• Alleviate the symptoms of perimenopause (hot flashes, moodiness, night sweats)

Cons

Oral contraceptives may:

• Increase the risk of blood clots, particularly after age 35 (my biggest con)
• Increase the risk of glaucoma, a serious eye condition that leads to progressive damage of the optic nerve, in women aged 40 or older who took the pill for three or more years
• Possibly increase the risk of multiple sclerosis, according to a PLoS One study, although the association was weak and likely attributable to other factors
• Possibly increase the risk of breast cancer, especially in those with a significant family history of breast cancer
• Possibly increase the risk of suicide according to a study in The American Journal of Psychiatry

The Final Decision

So what did I finally decide? The recent changes in my body’s response to the pill have certainly given me pause. Is the dizziness just the first sign that I may not tolerate the pill as well as I did when I was younger? What about my risk for blood clots as a woman over 40 –- and my family history of heart disease?

After giving it much thought, I’ve decided that the life-changing benefits of the pill, for me, are worth the potential risks right now. It’s important that I’m able to work when I need to and crucial to know that I won’t spend two days a month with debilitating cramps, headaches, and nausea.

At the same time, I better understand my risks now and that has led me to make a few other decisions. I’m going to schedule an appointment with a cardiologist and have a full workup on my heart health. I want a clean bill of health so I can fill my prescription each month with a clear conscience, knowing I don’t have an arrhythmia, my cholesterol is low, my heart is healthy, and my personal risk of taking a birth control pill after age 40 is no greater than the average person’s. I will also keep a careful watch on how my body responds to the pill and on side effects such as dizziness.

For me, that will be enough security to continue taking the pill until I hit 50. At that point, I’ll be heading toward menopause, and when that time comes, I plan on being a more informed patient. I’ll do my research, consider my options, and make the best decision for my body -– and my health.